ACAM-FLU-A - Purpose and Benefits of Annual Flu Vaccination - Effectiveness of Vaccine

Effectiveness of Vaccine

A vaccine is assessed by its efficacy, the extent to which it reduces risk of disease under controlled conditions, and its effectiveness, the observed reduction in risk after the vaccine is put into use. In the case of influenza, effectiveness is expected to be lower than the efficacy because it is measured using the rates of influenza-like illness, which is not always caused by influenza. Influenza vaccines generally show high efficacy, as measured by the antibody production induced in animal models or vaccinated people, or most rigorously, by immunizing healthy adult volunteers and then challenging them with virulent influenza virus. However, studies on the effectiveness of flu vaccines in the real world are uniquely difficult; vaccines may be imperfectly matched, virus prevalence varies widely between years, and influenza is often confused with other influenza-like illnesses. However, in most years (16 of the 19 years before 2007), the flu vaccine strains have been a good match for the circulating strains, and even a mis-matched vaccine can often provide cross-protection.

Nevertheless, multiple clinical trials of both live and inactivated influenza vaccines against seasonal influenza have been performed and their results pooled and analyzed in several 2012 meta-analyses. Studies on live vaccines have very limited data, but these preparations may be more effective than inactivated vaccines. The meta-analyses examined the efficacy and effectiveness of inactivated vaccines against seasonal influenza in adults, children, and the elderly. In adults, vaccines show a three-quarters reduction in risk of contracting influenza (4% influenza rate among the unvaccinated versus 1% among vaccinated persons) when the vaccine is perfectly matched to the virus and a one-half reduction (2% get flu without vaccine versus 1% with vaccine) when it is not, but no significant effect on the rate of hospitalization. However, the risk of serious complications from influenza is small in adults, so unless the effect from vaccination is large it might not have been detected. In children, vaccines again showed high efficacy, but low effectiveness in preventing "flu-like illness". In children under the age of two the data are extremely limited, but vaccination appeared to confer no measurable benefit. In the elderly, while many individual studies show effectiveness, the overall evidence is still insufficient evidence to draw clear conclusions on the effectiveness of vaccination, including a new high-dose flu vaccine specificially formulated to provide a larger immune response. Available evidence indicates that the high-dose vaccine produces a stronger immune response, and a study designed to determine the effectiveness of Fluzone High-Dose in preventing illness from influenza compared with Fluzone is expected to be completed in 2014–2015.

During an influenza pandemic, where a single strain of virus is responsible for illnesses, an effective vaccine could produce a large decrease in the number of cases and be highly effective in controlling an epidemic. However, such a vaccine would have to be produced and distributed rapidly to have maximum effect. Such distribution challenges may be met, with good success. Overall, vaccines against the 2009 H1N1 influenza pandemic were found to be effective in a Scottish study.

A 2011 meta-study published in the journal The Lancet, "Efficacy and Effectiveness of Influenza Vaccines," analyzed 31 prior studies on the effectiveness of influenza vaccination trials conducted between 1967 and 2011. The analysis found that flu shots were efficacious 67 percent of the time; the populations that benefited the most were HIV-positive adults ages 18 to 55 (76 percent), healthy adults ages 18 to 46 (approximately 70 percent) and healthy children ages 6 to 24 months (66 percent).

The group most vulnerable to non-pandemic flu, the elderly, is also the least to benefit from the vaccine. There are multiple reasons behind this steep decline in vaccine efficacy, the most common of which are the declining immunological function and frailty associated with advanced age. In a non-pandemic year, a person in the United States aged 50–64 is nearly ten times more likely to die an influenza-associated death than a younger person, and a person over age 65 is over ten times more likely to die an influenza-associated death than the 50–64 age group.

As mortality is also high among infants who contract influenza, the household contacts and caregivers of infants should be vaccinated to reduce the risk of passing an influenza infection to the infant. Data from the years when Japan required annual flu vaccinations for school-aged children indicate that vaccinating children—the group most likely to catch and spread the disease—has a strikingly positive effect on reducing mortality among older people, due to herd immunity: one life saved for every 420 children who received the flu vaccine. However, a 2010 Cochrane review found that the same benefit did not extend to vaccinating health care workers working with elderly patients in long-term care facilities. In working adults, by contrast, Cochrane found that vaccination reduced both influenza symptoms and working days lost, without affecting transmission or influenza-related complications.

Read more about this topic:  ACAM-FLU-A, Purpose and Benefits of Annual Flu Vaccination

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